Chapter 38 My Nursing Test Banks

 

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E
Chapter 38

Question 1

Type: MCSA

The client tells the nurse that her symptoms have become worse since she has been using oxymetazoline (Afrin) for nasal congestion. What is the best assessment question for the nurse to ask?

1. How old is the bottle you are using?

2. May I take your temperature?

3. Are you using any other inhaled medications?

4. How long have you been using the medication?

Correct Answer: 4

Rationale 1: While it is possible that the client is using outdated medication, this is not the best question.

Rationale 2: Asking to take the clients temperature is not the best question.

Rationale 3: The use of other inhaled medications will not cause or prevent rebound congestion, so this question is unnecessary.

Rationale 4: Oxymetazoline (Afrin) can cause rebound congestion if used for too long, so length of treatment is the best assessment question.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 38-4

Question 2

Type: MCSA

Which assessment finding, by the nurse, is a priority concern when a client receives pseudoephedrine (Sudafed)?

1. Temperature of 100 F

2. Respiratory rate of 22

3. Heart rate 82 and irregular

4. Complaints of a dry mouth

Correct Answer: 3

Rationale 1: A temperature is possible with pseudoephedrine , but is not the primary concern.

Rationale 2: A respiratory rate of 22 is possible with pseudoephedrine, but is not the primary concern.

Rationale 3: Pseudoephedrine may cause dysrhythmias.

Rationale 4: A dry mouth is possible with pseudoephedrine but is not the primary concern.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 38-4

Question 3

Type: MCSA

The elderly client receives diphenhydramine (Benadryl) for allergies. The nurse completes medication education and evaluates that learning has occurred when the client makes which statement?

1. Drowsiness is common but should lessen within a few doses.

2. If this medication makes my nose run, I can use a nasal spray.

3. I need to watch my intake of sodium with this medication.

4. I cannot take this medication with pseudoephedrine (Sudafed).

Correct Answer: 1

Rationale 1: Drowsiness is a common adverse effect of antihistamines. The client should develop a tolerance to this effect within a few doses.

Rationale 2: Antihistamines would dry the nasal secretions, not increase them.

Rationale 3: Sodium intake is not related to antihistamines.

Rationale 4: Pseudoephedrine (Sudafed) is commonly used with antihistamines.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 38-7

Question 4

Type: MCSA

The nurse completes medication education for the client receiving antihistamines. The nurse evaluates that learning has occurred when the client makes which statement?

1. I can still have my after-dinner drink.

2. I need to increase fluids while taking this medication.

3. This medication is safe because it is sold over-the-counter (OTC).

4. This medication could make me very sleepy.

Correct Answer: 4

Rationale 1: Alcohol will increase the sedative effects of antihistamines, so the client should not drink while taking antihistamines.

Rationale 2: There is no need to increase fluids when taking antihistamines.

Rationale 3: Just because a medicine is sold over-the-counter (OTC), does not mean it is safe.

Rationale 4: Sedation is a common side effect of antihistamines.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 38-3

Question 5

Type: MCMA

The nursing instructor teaches the nursing students about the major functions of the upper respiratory tract. What will the best plan by the nursing instructor include?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Inward airflow from the trachea branches off to the two bronchi.

2. The nose warms the air before it reaches the lungs.

3. The nasal mucosa is the first line of immunological defense.

4. Activation of the parasympathetic nervous system constricts arterioles in the nose.

5. Activation of the sympathetic nervous system constricts arterioles in the nose.

Correct Answer: 2,3,5

Rationale 1: The trachea and bronchi are part of the lower respiratory tract.

Rationale 2: The nose warms the air before it reaches the lungs.

Rationale 3: The nasal mucosa is the first line of immunological defense.

Rationale 4: Activation of the sympathetic nervous system, not the parasympathetic nervous system, constricts arterioles in the nose.

Rationale 5: Activation of the sympathetic nervous system constricts arterioles in the nose.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 38-1

Question 6

Type: MCMA

The client has allergic rhinitis and asks the nurse what causes this. How should the nurse respond?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. It can occur after exposure to animal dander.

2. Tobacco smoke causes it in some people.

3. Exposure to pollens from weeds and grass cause an allergic response in some people.

4. It is caused by asthma.

5. You inherited the predisposition for this.

Correct Answer: 1,2,3,5

Rationale 1: One of the causative factors for allergic rhinitis is animal dander.

Rationale 2: Tobacco smoke causes the allergic rhinitis reaction in some people.

Rationale 3: Allergic response to pollen can cause allergic rhinitis in some people.

Rationale 4: Although associated with asthma, allergic rhinitis is not caused by asthma.

Rationale 5: There is a strong genetic predisposition for allergic rhinitis.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 38-2

Question 7

Type: MCSA

The nursing instructor teaches the student nurses about histamine receptors and evaluates that further instruction is needed when the students make which statement?

1. H1-receptors are found in the stomach.

2. H1-receptors are responsible for allergic symptoms.

3. H2-receptors increase mucus secretion in the stomach.

4. H2-receptors are responsible for peptic ulcers.

Correct Answer: 1

Rationale 1: H2-receptors are found in the stomach.

Rationale 2: The histamine receptors responsible for allergic symptoms are called H1 receptors.

Rationale 3: H2-receptors increase mucus secretion in the stomach.

Rationale 4: H2-receptors are responsible for peptic ulcers.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 38-3

Question 8

Type: MCSA

The client receives diphenhydramine (Benadryl) to control allergic symptoms. Which common symptom does the nurse teach the client to report to the physician?

1. Sedation

2. Diarrhea

3. Projectile vomiting

4. Urinary hesitancy

Correct Answer: 4

Rationale 1: Sedation is a common side effect, but does not need to be reported.

Rationale 2: Diarrhea is not a common side effect.

Rationale 3: Projectile vomiting is not a common side effect.

Rationale 4: Urinary hesitancy is an anticholinergic effect of diphenhydramine (Benadryl) and should be reported to the physician.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 38-7

Question 9

Type: MCSA

The client receives beclomethasone (Beconase) intranasally as treatment for allergic rhinitis. He asks the nurse if this drug is safe because it is a glucocorticoid. What is the best response by the nurse?

1. Intranasal glucocorticoids produce almost no serious adverse effects.

2. Intranasal glucocorticoids are safe if you do not swallow any while using them.

3. Intranasal glucocorticoids are safe if they are not used too long.

4. Intranasal glucocorticoids are safe only if used once a day.

Correct Answer: 1

Rationale 1: Intranasal glucocorticoids produce almost no serious adverse effects.

Rationale 2: Swallowing glucocorticoids used for intranasal application could potentially cause reactions, but large amounts would need to be swallowed. This option states they are dangerous if swallowed in any quantity.

Rationale 3: There is no time frame for the use of intranasal glucocorticoids; they produce almost no serious adverse effects.

Rationale 4: Intranasal glucocorticoids may be used more than once a day; they produce almost no serious adverse effects.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 38-8

Question 10

Type: MCSA

The nurse teaches the client about the difference between oral and nasal decongestants. The nurse evaluates that learning has been effective when the client makes which statement?

1. Oral decongestants can cause hypertension.

2. Intranasal decongestants are safe to use for a month, if needed.

3. Oral and nasal decongestants can cause rebound congestion.

4. Oral decongestants are the most effective at relieving severe congestion.

Correct Answer: 1

Rationale 1: One of the side effects of oral decongestants is hypertension.

Rationale 2: Intranasal decongestants should not be used for longer than 3 to 5 days.

Rationale 3: Oral decongestants do not cause rebound congestion; nasal decongestants can cause rebound congestion.

Rationale 4: Intranasal, not oral, decongestants are the most effective at relieving severe congestion.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 38-4

Question 11

Type: MCSA

A mother asks the nurse when she should give her child cough medicine. What is the best response by the nurse?

1. When he is coughing up green secretions.

2. When he has a temperature over 102F.

3. When he has bronchitis.

4. When he has a dry cough and cannot rest.

Correct Answer: 4

Rationale 1: If the client is coughing up green secretions, he needs to receive an antibiotic, not cough medicine. The child needs to clear these secretions so a cough suppressant would not be used.

Rationale 2: If a client is febrile, he needs an assessment prior to receiving cough medication.

Rationale 3: It is not desirable to suppress the cough reflex in a client with bronchitis; the child should not receive cough medicine.

Rationale 4: Dry, hacking, and nonproductive cough is irritating to the membranes of the throat and deprives the client of much needed rest, so a cough medicine would be warranted in this case.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 38-5

Question 12

Type: MCSA

The physician prescribes fluticasone (Flonase) for the client. The nurse would hold the drug and contact the physician with which assessment finding?

1. The client has diabetes mellitus.

2. The client is pregnant.

3. The client has glaucoma.

4. The client has hypertension.

Correct Answer: 2

Rationale 1: There is no contraindication for use of this drug in a client who has diabetes mellitus.

Rationale 2: This is a class C drug so effects on pregnancy are not known; the client should not receive this drug.

Rationale 3: There is no contraindication for use of this drug in a client diagnosed with glaucoma.

Rationale 4: There is no indication that use of this drug is contraindicated in the client who is hypertensive.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 38-7

Question 13

Type: MCSA

The client is very frustrated that pseudoephedrine is no longer stocked on pharmacy shelves. The client does not like to go the pharmacy counter to obtain the drug. What is the best response by the nurse?

1. This is frustrating, but hopefully it will decrease the amount of methamphetamine being produced.

2. This is frustrating, but hopefully it will decrease the amount of inhaled heroin being produced.

3. This is frustrating, but hopefully it will decrease the amount of methylphenidate being produced.

4. This is frustrating, but hopefully it will decrease the amount of crack cocaine being produced.

Correct Answer: 1

Rationale 1: Pseudoephedrine (Sudafed) is a major ingredient in the production of methamphetamine.

Rationale 2: Pseudoephedrine (Sudafed) is a major ingredient in the production of methamphetamine, not heroin.

Rationale 3: Pseudoephedrine (Sudafed) is a major ingredient in the production of methamphetamine, not methylphenidate.

Rationale 4: Pseudoephedrine (Sudafed) is a major ingredient in the production of methamphetamine, not crack cocaine.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 38-8

Question 14

Type: MCSA

The client takes diphenhydramine (Benadryl), but forgets to tell the physician about this drug when a monoamine oxidase inhibitor (MAOI) drug is prescribed for depression. What will the best assessment by the nurse reveal?

1. The depression will not subside.

2. The client may develop seizures.

3. The diphenhydramine (Benadryl) will not control allergies.

4. The client may develop a hypertensive crisis.

Correct Answer: 4

Rationale 1: Depression is not the concern with this combination.

Rationale 2: Seizures are not the concern with this combination.

Rationale 3: Control of allergies is not the concern with this combination.

Rationale 4: The combination of diphenhydramine (Benadryl) and a monoamine oxidase inhibitor (MAOI) drug can result in a hypertensive crisis.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 38-7

Question 15

Type: MCSA

The upper respiratory tract (URT) consists of the nose, nasal cavity, pharynx, and paranasal sinuses. It undergoes a process sometimes referred to as

1. filtering.

2. warm conditioning.

3. air conditioning.

4. absorbing.

Correct Answer: 3

Rationale 1: Filtering does not occur in this process.

Rationale 2: It does not warm condition in this process.

Rationale 3: It does undergo a process referred to as air conditioning.

Rationale 4: Absorbing does not occur in this process.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 38-1

Question 16

Type: MCSA

Antihistamines block the actions of histamine at the

1. H1 receptor site.

2. B1 receptor site.

3. B2 receptor site.

4. C1 receptor site.

Correct Answer: 1

Rationale 1: The H1 receptor site is the site for blocking histamine with the use of antihistamines.

Rationale 2: The B1 receptor site does not play a role in blocking histamine.

Rationale 3: The B2 receptor site does not play a role in blocking histamine.

Rationale 4: C1 is not a site of histamine release.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 38-3

Question 17

Type: MCSA

Oral decongestants differ from intranasal decongestants in that oral decongestants

1. are more effective at relieving severe congestion.

2. have more systemic effects.

3. can cause rebound congestion.

4. have high efficacy.

Correct Answer: 2

Rationale 1: Oral decongestants are less effective at relieving severe congestion.

Rationale 2: Oral decongestants can have more systemic effects.

Rationale 3: Intranasal decongestants can cause rebound congestion after more than 5 days of use.

Rationale 4: Intranasal decongestants are higher in efficacy.

Global Rationale:

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 38-4

Question 18

Type: MCSA

Which of the following over-the-counter (OTC) antihistamine combinations contains an analgesic property?

1. Sudafed PE Nighttime Allergy

2. Triaminic Cold/Allergy

3. Tavist Allergy 12-hour

4. Actifed Plus

Correct Answer: 4

Rationale 1: Sudafed PE Nighttime Allergy contains diphenhydramine and phenylephrine.

Rationale 2: Triaminic Cold/Allergy contains chlorpheniramine and phenylephrine.

Rationale 3: Tavist Allergy 12-hour contains clemastine.

Rationale 4: Actifed Plus contains acetaminophen.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 38-7

Question 19

Type: MCSA

Centrally acting antitussives, such as opioids, are used to

1. decrease nasal congestion.

2. break down mucus.

3. relieve severe cough.

4. relieve mild cough.

Correct Answer: 3

Rationale 1: Decongestants decrease congestion.

Rationale 2: Expectorants break down mucus.

Rationale 3: Opioids relieve severe cough.

Rationale 4: Non-opioid antitussives relieve mild cough.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 38- 5

Question 20

Type: MCSA

The main classification for a prototype drug, such as fexofenadine (Allegra), is a/n

1. atypical second generation H2-receptor antagonist.

2. typical first-generation H1-receptor antagonist.

3. atypical first generation H1-receptor antagonist.

4. typical second-generation H1-receptor antagonist.

Correct Answer: 4

Rationale 1: Fexofenadine (Allegra) is not an atypical H2-receptor antagonist.

Rationale 2: Fexofenadine (Allegra) is not a typical first-generation H1-receptor.

Rationale 3: Fexofenadine (Allegra) is not an atypical H1-receptor antagonist.

Rationale 4: Fexofenadine (Allegra) is a typical second-generation H1-receptor antagonist.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 38-7

Question 21

Type: MCMA

A client calls the nurse help-line and says, My friend and I have been swimming and drinking beer all day and he took a couple of swigs of Robitussin DM (dextromethorphan) about 15 minutes ago. Now he is acting funny and seeing things. What should the nurse consider when formulating a response?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

Correct Answer:

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 38.6

Question 22

Type: MCMA

A client with chronic bronchitis is to start receiving breathing treatments with Acetylcysteine (Mucomyst). Which information should the nurse include in teaching about this medication?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Your pharmacist can order this for you to purchase as an over-the-counter drug.

2. Stop the treatment if you start to cough.

3. This drug has a very short shelf-life, so if it smells bad do not use it.

4. This drug is designed to break down and thin the mucus in your lungs.

5. You might experience nausea while using this drug.

Correct Answer: 4,5

Rationale 1: This drug is by prescription only.

Rationale 2: This medication is designed to thin mucus to make it easier to remove by coughing. Coughing is a desired effect.

Rationale 3: Acetylcysteine has the odor of rotten eggs. This is not an indication that it is past the recommended use date or that it has gone bad.

Rationale 4: This drug is a mucolytic and is designed to thin mucus by breaking down the chemical structure.

Rationale 5: One of the adverse effects of acetylcysteine is nausea.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 38.6

Question 23

Type: MCMA

A client has been prescribed the opioid combination drug Hycomine Compound for control of cough. This drug contains hydrocodone, phenylephrine, chlorpheniramine, and acetaminophen. Which instructions should the nurse provide as part of medication education?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Drink a full glass of water when taking this medication.

2. Keep this medication at your bedside so you can take it as needed.

3. Take this drug exactly as indicated.

4. If you have head or body aches you may take any over-the-counter analgesic.

5. Do not make important decisions or operate machinery while taking this drug.

Correct Answer: 3,5

Rationale 1: The medication should be taken without water and the client should not drink anything for 3060 minutes.

Rationale 2: Hydrocodone is an opioid with the adverse effect of drowsiness. The client may inadvertently overdose if taking as needed or if taking doses while drowsy.

Rationale 3: Taking too much of this drug can cause oversedation. It also contains acetaminophen which should be taken only as directed.

Rationale 4: The client should not take any other preparation that contains acetaminophen to avoid overdose.

Rationale 5: The hydrocodone component of this drug will make the client drowsy and may impact the ability to make decisions.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 38.8

Question 24

Type: MCMA

The client is prescribed a nasal decongestant spray. What information should the nurse include when educating the client about how to use this medication?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Blow your nose immediately before using the medication.

2. Drink a full glass of water immediately before using this spray.

3. Limit your use of this spray to no more than 5 days.

4. Since you are using more than one type of nasal spray, be sure to wait 510 minutes between administrations.

5. You should spit out any excess spray that drains into your mouth.

Correct Answer: 1,3,4,5

Rationale 1: The nasal passages should be cleared by blowing the nose immediately before the medication is administered.

Rationale 2: Fluids should be increased, but it is not necessary to drink a glass of water immediately before using the spray.

Rationale 3: Nasal decongestant sprays should not be used for more that 35 days.

Rationale 4: The client should wait 510 minutes between administering different nasal sprays to allow the first medication some time to work before the second one is used.

Rationale 5: Excess spray should not be swallowed as systemic effects may occur.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 38.8

Question 25

Type: MCMA

A client is prescribed an intranasal corticosteroid. What should the nurse include in client education about this drug?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. You may feel a burning sensation when using this drug.

2. This drug will be most effective if used only when symptoms are present.

3. Be careful of how hard you squeeze the container as you can inadvertently give yourself too much medication for one dose.

4. This medication may dry out your nasal passages enough to cause nosebleed.

5. Do not eat licorice while taking this drug.

Correct Answer: 1,4,5

Rationale 1: The most frequently reported adverse effect of this drug is an intense burning sensation in the nose occurring immediately after spraying.

Rationale 2: The drug often takes 1 to 3 weeks to achieve peak response and should be started in advance of expected need.

Rationale 3: The medications are provided in metered-spray devices.

Rationale 4: Excessive drying of the nasal mucosa may occur, which leads to epistaxis.

Rationale 5: Licorice may potentiate the effects of corticosteroids.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 38.4

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E

Copyright 2014 by Pearson Education, Inc.

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